Cognitive deficits in multiple system atrophy correlate with frontal atrophy and disease duration

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Abstract
Background and purpose:  Dementia remains an exclusion criterion in diagnosing multiple system atrophy (MSA). This study aimed to determine the cognitive changes and brain atrophy patterns in the Parkinsonian (MSA‐P) and cerebellar (MSA‐C) variants of MSA.Methods:  Voxel‐based morphometry (VBM) of magnetic resonance imaging (MRI) and neuro‐psychological tests were applied to 10 MSA‐C and 13 MSA‐P patients, and compared to 37 age‐matched controls. Correlation analyses were performed between cognitive test results and morphometric data extracted from the VBM data.Results:  In neuro‐psychological testing, the 23 MSA patients scored lower in the Stroop interference test and took longer in the trail‐making test as compared with the controls, whereas MSA‐C performed worse than MSA‐P in the memory scores, Stroop test, and time to complete the trail‐making test. MSA, as a group, showed atrophy in the cerebellum, insular cortex, fusiform gyrus, inferior orbito‐frontal gyrus, superior temporal gyrus, and caudate nucleus. Memory scores correlated well with pre‐frontal lobe atrophy but not in the insular area.Conclusion:  In conclusion, although dementia is not a typical presenting feature of MSA and is regarded as a sub‐cortical movement disorder, frontal atrophy, cognitive changes, and dementia are identifiable as MSA progresses.

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